Shadow Pandemic: Eating Disorders In the time of COVID-19

photo of sad looking girl

The COVID-19 pandemic led to an increase in the prevalence and severity of eating disorders (ED) worldwide. Although eating disorders were already on the rise, The National Eating Disorders Association (NEDA) reported a 70-80% increase in calls and messages to their helpline during some months of the pandemic.1,3 In one large Canadian study, the number of new eating disorder diagnoses increased from 24 per month prior to the pandemic to greater than 40 cases per month during the first wave of COVID-19.2 In another large American study, outpatient visits increased by 50% and inpatient admissions peaked to 200% of pre-pandemic numbers.3. Moreover, the average length of hospital stay increased from 8-9 days to 12 days per hospitalization.3

An important article published in the International Journal of Eating Disorders in June of 2020 explained that “the COVID-19 pandemic created a “global context” likely to increase the risk and symptoms of eating disorders, decrease factors that protect against ED’s and exacerbate barriers to care.”4

Some of the factors that increased the risk and symptoms of eating disorders during the pandemic include:

  • Stress
  • Isolation
  • Disruption of daily routines and structure
  • Uncertainty
  • Food scarcity
  • Fear of contagion/food contamination
  • Focus on “healthy” eating for immunity
  • Diet culture and fear of “COVID 15” weight gain
  • Increased exposure to ED-specific or triggering media content
  • Exacerbation of co-occurring mental health conditions which can worsen ED symptoms (e.g., anxiety, OCD, PTSD, and others).

Meanwhile, factors which decreased risk and symptoms were harder to access for people including:

  • Social support
  • Family/group meals
  • Access to other coping strategies (e.g., outdoor activities)

Barriers to treatment also played a major role. My colleagues’ and I quickly filled our practices and were working beyond capacity. We had long waitlists and the patients were sicker by the time they reached us. Access to higher levels of care were also severely limited. Treatment centers faced a flood of referrals while juggling capacity limitations due to COVID-19 safety protocols. Additionally, job losses resulted in lack of insurance coverage for some individuals and families making treatment financially inaccessible.

Although the rise in eating disorders during the pandemic is disheartening, there are some potential positive outcomes of this “shadow pandemic”. For example, some of these include:

  • Increased awareness of gaps in care,
  • Increased access to ED care via the use of telehealth
  • Increased awareness of biases about who gets eating disorders including a gender, socioeconomic class, race, ability, age and ethnicity
  • Increased momentum for the Health At Every Size (HAES) movement and anti-diet culture
  • Increased awareness of weight biases in the field of medicine and elsewhere

As early intervention plays an important role in recovery, increased ED awareness has the potential to improve overall outcomes. By shining light on eating disorders, I am hopeful that the pandemic era will have a productive and enduring impact on eating disorder prevention, early intervention, and treatment.

To learn more about the author, please visit https://sarahlowenthalmd.com/

References:

  1. Katella, Kathy. Eating Disorders on The Rise After Our Pandemic Year. Yale Medicine., June 15, 2021.

  2. Agostino H, Burstein B, Moubayed D, et al. Trends in the Incidence of New-Onset Anorexia Nervosa and Atypical Anorexia Nervosa Among Youth During the COVID-19 Pandemic in Canada. JAMA Netw Open. 2021;4(12):e2137395. doi:10.1001/jamanetworkopen.2021.37395

  3. Asch DA, Buresh J, Allison KC, et al. Trends in US Patients Receiving Care for Eating Disorders and Other Common Behavioral Health Conditions Before and During the COVID-19 Pandemic. JAMA Netw Open. 2021;4(11):e2134913. doi:10.1001/jamanetworkopen.2021.34913

  4. Rodgers RF, Lombardo C, Cerolini S, et al. The impact of the COVIDÔÇÉ19 pandemic on eating disorder risk and symptoms. Int J Eat Disord. 2020;1–5. 10.1002/eat.23318

  5. Hildebrandt, T and Austin, S. “Keep the diet industry from feeding on teenagers’ fears.” Times Union. June 1, 2021.

  6. Raykos BC, Erceg-Hurn DM, Hill J, Campbell BNC, McEvoy PM. Positive outcomes from integrating telehealth into routine clinical practice for eating disorders during COVID-19. Int J Eat Disord. 2021 Sep;54(9):1689-1695. doi: 10.1002/eat.23574. Epub 2021 Jun 29. PMID: 34184797.

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